Healthcare Provider Details

I. General information

NPI: 1881355618
Provider Name (Legal Business Name): CASSANDRA NOVAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASEY NOVAK

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 DIVISADERO ST
SAN FRANCISCO CA
94143-3010
US

IV. Provider business mailing address

1501 N CAMPBELL AVE RM 4327
TUCSON AZ
85724-0001
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-4201
  • Fax:
Mailing address:
  • Phone: 520-626-9383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA68457
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: